Gross total resection of glioblastoma may prolong survival with modern radiation therapy and chemotherapy, according to new research from the German Glioma Network. However, incomplete resection appears no better than a biopsy.
“There is no linearity such as ‘70% resection is better than 50%,'” said Dr. Joerg-Christian Tonn from University of Munich LMU, who led the new work. “The goal must be (if anatomically and clinically feasible) to resect all the solid tumor mass — this makes the difference.”
Among the 222 patients (64.2%) who underwent radiotherapy plus chemotherapy, median overall survival was significantly longer after gross total resection (21.0 months) than after incomplete resection (15.2 months) or biopsy (15.7 months). In multivariate Cox regression analyses, independent predictors of better overall survival included gross total resection, age 60 years or less, Karnofsky performance score of 80 or higher, MGMT promoter methylation, and radiotherapy plus chemotherapy. Incomplete resection was no better than biopsy.
for those unable to have a complete resection, Dr. Samuel Ryu from Gachon University Gil Hospital in Inchon, Korea, made a case for incomplete resection, even if it has no survival benefits: “The role of surgical resection also includes removal or reduction of mass effect,” he told Reuters Health by email. “Although there is no survival benefit, there can be some neurological benefit by reducing the pressure to the adjacent brain parenchyma.”
And there is this eloquent criticism of the paper, too:
Dr. Sonia Tejada from Universidad de Navarra in Spain, questioned whether there are meaningful conclusions to be drawn from the new work. “I am surprised that this article that does not give any new data in the field has been published in this journal,” she said. “Nowadays,” Dr. Tejada noted, “a paper about resection in glioblastoma without volumetric analysis is incomplete and should not have been published. Indeed, the data about overall survival in the group of incomplete resection was 11.7 (10.0-13.5) months and in the group of biopsy was 8.7 (6.3-11.2) months. Although not statistically significant, there is a difference; the absence of significance does not mean an absence of difference.”
I’m Dr. Michael Hunter.
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Reference: http://www.medscape.com/viewarticle/814079; Annals of Oncology 2013